LAUSR

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: A 23 year old female presented with a two day history of headache, fever, and increasing confusion. Blood cultures, CSF cytology, cultures, and immune binding studies were negative. MRI imaging of the brain demonstrated edema in the left basal ganglia and superior medial temporal lobe without contrast enhancement. Isolated central nervous system mucormycosis is a rare diagnosis with high morbidity and mortality. Statistical review of the limited number of published cases with identify prognostic indicators of mortality. Methods: We searched the medical literature for cases of isolated cerebral mucormycosis reviewing the case data and exhaustively searching each manuscript’s bibliography. We identified a total of 66 patients, recording: patient age, sex, history of intravenous drug abuse, HIV status, medical co-morbidities, presenting symptoms, admission temp, sedimentation rate, C-reactive protein, peripheral WBC with differential, CSF cytology, CSF cultures, tissue cultures, and treatment regimen. Data was analyzed using univariate and multivariate linear regression models with imputation techniques and bootstrapping to account for missing variables. Results: Median age of the patients was 28 years with a interquartile range of 14 to 16. The cohort was 58% male, 11% were HIV positive, and 71% had a history of IV drug abuse. Common symptoms were: altered mental status, headache, fever, and hemiparesis. Culture results where only reported in 35% of cases with the most common organism from the Rhizopus genus. Potential univariate predictors of mortality were: altered mental status, basal ganglia lesion, bilateral lesions, and elevated CSF protein. Multivariable analysis predictors of mortality were: altered mental status, elevated CSF protein, and bilateral lesions with a model discrimination c-statistic/Area Under Curve = 0.81. Conclusions: Isolated cerebral mucormycosis is challenging diagnosis with a high mortality rate (65%) with therapy. The most significant prognostic indicators of mortality are: altered mental status, elevated CSF protein, and bilateral lesions.